Optimisation of coronary angiographic views: Qualitative and quantitative evaluation of a new system

A coronary angiographic view is said to be ''optimal'' when the directing radius of the X-ray beam is perpendicular to the long axis of a stenosis. The object was to fulfill two criteria : 1) the accurate calculation of the spatial orientation of the stenosis to obtain the optimal position, 2) rapid and optimal positioning of the angiographic material with easy rotation around the axis of the stenosis. Two combined solutions were proposed : the Advantx L/C (GE Medical systems) angiocardiographic system with three motorised axes of rotation and a specific software. This software takes into account two longitudinal axes of the stenosis traced by the operator in two conventional incidences and then determines the angles of optimal positioning (accuracy +/- 5 degrees). During 97 consecutive coronary angiogrammes, the software was used in 23 cases (24 %) and judged to be useful in 16 cases (70 %). In 2 of the 23 cases (8 %) the mechanical angles calculated could not be used, the incidences being incompatible with the patient's position. During the angiogrammes, the best two images of stenosis (one conventional, one optimal) were retained to form a pair of images. Eight observers analysed 37 pairs of images shown side by side. 65 % of the images selected from each pair as being the best descriptive appearance of the stenosis came from the optimised system. During quantitative analysis, only the length of stenosis differed statistically between the two modes of acquisition (1.26 +/- 0.36 mm; p = 0.0014). This system is useful during coronary angiography for providing optimal views of stenosis free from any geometric distorsion and without superimposition of adjacent branches.